Description:
This phase II trial studies how well paclitaxel and carboplatin before radiation therapy with
paclitaxel works in treating human papillomavirus (HPV)-positive patients with stage III-IV
oropharynx, hypopharynx, or larynx cancer. Drugs used in chemotherapy, such as paclitaxel and
carboplatin, work in different ways to stop the growth of tumor cells, either by killing the
cells or by stopping them from dividing. Radiation therapy uses high energy x rays to kill
tumor cells. Giving paclitaxel and carboplatin before radiation therapy with paclitaxel may
kill more tumor cells.
Title
- Brief Title: Paclitaxel and Carboplatin Before Radiation Therapy With Paclitaxel in Treating HPV-Positive Patients With Stage III-IV Oropharynx, Hypopharynx, or Larynx Cancer
- Official Title: Phase II Trial Of Induction Chemotherapy Followed By Attenuated Chemoradiotherapy For Locally Advanced Head And Neck Squamous Cell Carcinoma Associated With Human Papillomavirus (HPV)
Clinical Trial IDs
- ORG STUDY ID:
13-000915
- SECONDARY ID:
NCI-2013-02394
- SECONDARY ID:
13-000915
- SECONDARY ID:
P30CA016042
- NCT ID:
NCT02048020
Conditions
- Human Papilloma Virus Infection
- Stage III Squamous Cell Carcinoma of the Hypopharynx
- Stage III Squamous Cell Carcinoma of the Larynx
- Stage III Squamous Cell Carcinoma of the Oropharynx
- Stage III Verrucous Carcinoma of the Larynx
- Stage IV Squamous Cell Carcinoma of the Hypopharynx
- Stage IV Verrucous Carcinoma of the Larynx
- Stage IVA Squamous Cell Carcinoma of the Larynx
- Stage IVA Squamous Cell Carcinoma of the Oropharynx
- Stage IVA Verrucous Carcinoma of the Larynx
- Stage IVB Squamous Cell Carcinoma of the Larynx
- Stage IVB Squamous Cell Carcinoma of the Oropharynx
- Stage IVB Verrucous Carcinoma of the Larynx
- Stage IVC Squamous Cell Carcinoma of the Larynx
- Stage IVC Squamous Cell Carcinoma of the Oropharynx
- Stage IVC Verrucous Carcinoma of the Larynx
Interventions
Drug | Synonyms | Arms |
---|
paclitaxel | Anzatax, Asotax, TAX, Taxol | Treatment (paclitaxel, carboplatin, IMRT) |
carboplatin | Carboplat, CBDCA, JM-8, Paraplat, Paraplatin | Treatment (paclitaxel, carboplatin, IMRT) |
Purpose
This phase II trial studies how well paclitaxel and carboplatin before radiation therapy with
paclitaxel works in treating human papillomavirus (HPV)-positive patients with stage III-IV
oropharynx, hypopharynx, or larynx cancer. Drugs used in chemotherapy, such as paclitaxel and
carboplatin, work in different ways to stop the growth of tumor cells, either by killing the
cells or by stopping them from dividing. Radiation therapy uses high energy x rays to kill
tumor cells. Giving paclitaxel and carboplatin before radiation therapy with paclitaxel may
kill more tumor cells.
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the progression-free survival at 2 years in patients with HPV-positive head
and neck squamous cell carcinoma (HNSCC) who receive induction chemotherapy followed by dose
de-intensified chemoradiotherapy.
SECONDARY OBJECTIVES:
I. To determine the overall survival and local-regional control for patients with
HPV-positive HNSCC who receive induction chemotherapy and dose de-intensified
chemoradiotherapy.
II. To determine the incidence of acute grade 3+ mucosal and esophageal toxicity associated
with attenuated concurrent chemoradiotherapy in patients with HPV-positive HNSCC.
III. To determine the incidence of late toxicity in patients with HPV-positive HNSCC who
receive the dose de-intensified chemoradiotherapy.
IV. To estimate the incidence of all toxicity (hematologic and non-hematologic) associated
with protocol treatment for all patients on trial.
V. To estimate the response rate of HPV-positive to induction chemotherapy using carboplatin
and paclitaxel.
VI. To determine the effect of reduced radiation dose on short-term and long-term quality of
life among patients treated by chemoradiotherapy.
OUTLINE:
INDUCTION: Patients receive paclitaxel intravenously (IV) over 3 hours and carboplatin IV
over 30 minutes. Treatment repeats every 21 days for up to 2 courses in the absence of
disease progression or unacceptable toxicity.
CHEMORADIOTHERAPY: At least 2 weeks after completion of induction chemotherapy, patients
receive paclitaxel IV over 1 hour weekly and undergo intensity-modulated radiation therapy
(IMRT) daily 5 days a week for 5.5 weeks in the absence of disease progression or
unacceptable toxicity.
After completion of study treatment, patients are followed up at 6, 9, and 12 months, every 3
months for 1 year, and then every 6 months for 2 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (paclitaxel, carboplatin, IMRT) | Experimental | INDUCTION: Patients receive paclitaxel IV over 3 hours and carboplatin IV over 30 minutes. Treatment repeats every 21 days for up to 2 courses in the absence of disease progression or unacceptable toxicity.
CHEMORADIOTHERAPY: At least 2 weeks after completion of induction chemotherapy, patients receive paclitaxel IV over 1 hour weekly and undergo IMRT daily 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Pathologically (histologically or cytologically) proven (from primary lesion and/or
lymph nodes) diagnosis of HPV-positive squamous cell carcinoma of the oropharynx,
hypopharynx, or larynx; HPV-positivity will be defined as tumors that are p16-positive
by immunohistochemistry
- Clinical stage III or IV disease; note: patients with M1 tumors are not eligible
- Appropriate stage for protocol entry, including no distant metastases, based upon the
following minimum diagnostic workup:
- History/physical examination within 4 weeks prior to registration, including
assessment of weight loss in past 6 months
- Chest x-ray (or chest computed tomography [CT] scan or positron emission
tomography [PET]/CT scan) within 6 weeks prior to registration
- CT scan or magnetic resonance imaging (MRI) of the head and neck (of the primary tumor
and neck nodes) and PET/CT scan
- Zubrod performance status 0-1
- Absolute neutrophil count (ANC) > 1,800 cells/mm^3
- Platelets > 100,000 cells/mm^3
- Hemoglobin (Hgb) > 8.0 g/dl (note: the use of transfusion or other intervention to
achieve Hgb > 8.0 g/dl is acceptable)
- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2x the upper
limit of normal
- Serum creatinine =< 1.5 mg/dl or institutional upper limit of normal
- Creatinine clearance (CC) >= 50 ml/min determined by 24-hour collection or estimated
by Cockcroft-Gault formula
- Negative serum pregnancy test within 7 days prior to start of induction chemotherapy
(ICT) for women of childbearing potential
- Women of childbearing potential and male participants are counseled on birth control
and must agree to use a medically effective means of birth control throughout their
participation in the treatment phase of the study (until at least 60 days following
the last study treatment)
- Patient must sign study specific informed consent prior to study entry
Exclusion Criteria:
- Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free
for a minimum of 3 years
- Patients with simultaneous primaries or bilateral tumors are excluded
- Patients who have had initial surgical treatment other than the diagnostic biopsy of
the primary site or nodal sampling of the neck disease are excluded
- Patients with unknown primary tumor sites are excluded
- Patients who present with a cervical lymph node metastasis of unknown primary origin
- Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a
different cancer is allowable
- Prior radiotherapy that would result in overlap of radiation therapy fields
- Primary site of tumor of oral cavity, nasopharynx, nasal cavity, paranasal sinuses, or
salivary glands
- Recurrent head and neck cancer
- Current uncontrolled cardiac disease; i.e., uncontrolled hypertension, unstable
angina, recent myocardial infarction (within prior 6 months), uncontrolled congestive
heart failure, and cardiomyopathy with decreased ejection fraction
- Congestive heart failure with left ventricular ejection fraction < 20%
- Transmural myocardial infarction within the last 6 months
- Acute bacterial or fungal infection requiring intravenous antibiotics at registration
- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy at the time of registration
- Active lupus erythematosus or scleroderma with ongoing physical manifestations
- Any uncontrolled condition, which in the opinion of the investigator, would interfere
in the safe and timely completion of study procedures
- Pregnant or lactating women or women of childbearing potential and men who are
sexually active and not willing/able to use medically acceptable forms of
contraception
- Prior allergic reaction to the study drug(s) involved in this protocol
- Patient is enrolled in another investigational trial
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 19 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression-free survival |
Time Frame: | From date of registration to date of first documentation of progression and/or distant metastasis, or death due to any cause, assessed at 2 years |
Safety Issue: | |
Description: | The true 2-year progression-free survival rate will be estimated by the proportion of efficacy-evaluable patients on study without documentation of disease progression or death 2 years from registration. A 95% confidence interval (CI) for the true progression-free survival rate will be constructed using the Duffy-Santner approach. However, Kaplan-Meier methodology will be used to estimate the final 2-year progression-free survival rate and its 95% CI in case there are censored patients. |
Secondary Outcome Measures
Measure: | Overall survival |
Time Frame: | The time from registration to death, assessed up to 5 years |
Safety Issue: | |
Description: | Time to event distributions will be estimated using the Kaplan-Meier method. |
Measure: | Local-regional control |
Time Frame: | 2 years |
Safety Issue: | |
Description: | The 2-year rates of local-regional control will be calculated along with 95% CI for HPV-positive patients receiving the dose de-intensified therapy. It will also be compared with the rate from historical controls using a one-sided Z-test. |
Measure: | Incidence of mucosal and esophageal >= grade 3 toxicity graded according to the National Cancer Institute Common Terminology for Adverse Events version 4.0 (NCI CTCAE v4.0) |
Time Frame: | Up to 12 weeks after chemoradiotherapy |
Safety Issue: | |
Description: | Rates and 95% CIs of grade 3+ mucosal and esophageal toxicity, late toxicity, other toxicities, protocol treatment delivery (PTD) and death during or within 30 days of discontinuation of protocol treatment will be calculated for the patients receiving the dose de-intensified therapy. |
Measure: | Incidence of other >= grade 3 toxicity graded according to NCI CTCAE v4.0 |
Time Frame: | Up to 12 weeks after chemoradiotherapy |
Safety Issue: | |
Description: | Rates and 95% CIs of grade 3+ mucosal and esophageal toxicity, late toxicity, other toxicities, PTD and death during or within 30 days of discontinuation of protocol treatment will be calculated for the patients receiving the dose de-intensified therapy. |
Measure: | PTD |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Rates and 95% CIs of grade 3+ mucosal and esophageal toxicity, late toxicity, other toxicities, PTD and death during or within 30 days of discontinuation of protocol treatment will be calculated for the patients receiving the dose de-intensified therapy. |
Measure: | Incidence of death |
Time Frame: | During or within 30 days of discontinuation of protocol treatment |
Safety Issue: | |
Description: | Rates and 95% CIs of grade 3+ mucosal and esophageal toxicity, late toxicity, other toxicities, PTD and death during or within 30 days of discontinuation of protocol treatment will be calculated for the patients receiving the dose de-intensified therapy. |
Measure: | Quality of life as assessed by Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) and University of Washington Quality of Life (UWQol) |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Descriptive statistics for quality of life measurements will also be obtained, using mean and standard deviation for continuous measures and frequency tables for categorical measures. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Jonsson Comprehensive Cancer Center |
Last Updated
August 14, 2018